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Sanders JE, Vamos AC, Mertens JC, Allyn KJ, Larsen BG, Ballesteros D, Wang H, DeGrasse NS, Garbini JL, Hafner BJ, Friedly JL. An adaptive prosthetic socket for people with transtibial amputation. Sci Rep 2024; 14:11168. [PMID: 38750086 PMCID: PMC11096356 DOI: 10.1038/s41598-024-61234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
It is essential that people with limb amputation maintain proper prosthetic socket fit to prevent injury. Monitoring and adjusting socket fit, for example by removing the prosthesis to add prosthetic socks, is burdensome and can adversely affect users' function and quality-of-life. This study presents results from take-home testing of a motor-driven adaptive socket that automatically adjusted socket size during walking. A socket fit metric was calculated from inductive sensor measurements of the distance between the elastomeric liner surrounding the residual limb and the socket's inner surface. A proportional-integral controller was implemented to adjust socket size. When tested on 12 participants with transtibial amputation, the controller was active a mean of 68% of the walking time. In general, participants who walked more than 20 min/day demonstrated greater activity, less doff time, and fewer manual socket size adjustments for the adaptive socket compared with a locked non-adjustable socket and a motor-driven socket that participants adjusted with a smartphone application. Nine of 12 participants reported that they would use a motor-driven adjustable socket if it were available as it would limit their socket fit issues. The size and weight of the adaptive socket were considered the most important variables to improve.
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Affiliation(s)
- Joan E Sanders
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA.
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph C Mertens
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Box 355061, Seattle, WA, 98195, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Box 352600, Seattle, WA, 98195, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Box 356490, Seattle, WA, 98195, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA, 98104, USA
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Baldock M, Pickard N, Prince M, Kirkwood S, Chadwell A, Howard D, Dickinson A, Kenney L, Gill N, Curtin S. Adjustable prosthetic sockets: a systematic review of industrial and research design characteristics and their justifications. J Neuroeng Rehabil 2023; 20:147. [PMID: 37926807 PMCID: PMC10626671 DOI: 10.1186/s12984-023-01270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The prosthetic socket is a key component that influences prosthesis satisfaction, with a poorly fitting prosthetic socket linked to prosthesis abandonment and reduced community participation. This paper reviews adjustable socket designs, as they have the potential to improve prosthetic fit and comfort through accommodating residual limb volume fluctuations and alleviating undue socket pressure. METHODS Systematic literature and patent searches were conducted across multiple databases to identify articles and patents that discussed adjustable prosthetic sockets. The patents were used to find companies, organisations, and institutions who currently sell adjustable sockets or who are developing devices. RESULTS 50 literature articles and 63 patents were identified for inclusion, representing 35 different designs used in literature and 16 commercially available products. Adjustable sockets are becoming more prevalent with 73% of publications (literature, patents, and news) occurring within the last ten years. Two key design characteristics were identified: principle of adjustability (inflatable bladders, moveable panels, circumferential adjustment, variable length), and surface form (conformable, rigid multi-DOF, and rigid single DOF). Inflatable bladders contributed to 40% of literature used designs with only one identified commercially available design (n = 16) using this approach. Whereas circumferential adjustment designs covered 75% of identified industry designs compared to only 36% of literature devices. Clinical studies were generally small in size and only 17.6% of them assessed a commercially available socket. DISCUSSION There are clear differences in the design focus taken by industry and researchers, with justification for choice of design and range of adjustment often being unclear. Whilst comfort is often reported as improved with an adjustable socket, the rationale behind this is not often discussed, and small study sizes reduce the outcome viability. Many adjustable sockets lack appropriate safety features to limit over or under tightening, which may present a risk of tissue damage or provide inadequate coupling, affecting function and satisfaction. Furthermore, the relationship between design and comfort or function are rarely investigated and remain a significant gap in the literature. Finally, this review highlights the need for improved collaboration between academia and industry, with a strong disconnect observed between commercial devices and published research studies.
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Affiliation(s)
- Michael Baldock
- School of Health and Society at the University of Salford, Salford, UK.
| | - Nicolaas Pickard
- School of Health and Society at the University of Salford, Salford, UK.
| | - Michael Prince
- School of Health and Society at the University of Salford, Salford, UK
| | - Sarah Kirkwood
- School of Health and Society at the University of Salford, Salford, UK
| | - Alix Chadwell
- School of Health and Society at the University of Salford, Salford, UK
- School of Engineering at Newcastle University, Newcastle upon Tyne, UK
| | - David Howard
- School of Health and Society at the University of Salford, Salford, UK
| | - Alex Dickinson
- School of Engineering at the University of Southampton, Southampton, UK
| | - Laurence Kenney
- School of Health and Society at the University of Salford, Salford, UK
| | - Niamh Gill
- School of Health and Society at the University of Salford, Salford, UK
| | - Sam Curtin
- School of Health and Society at the University of Salford, Salford, UK.
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Lanahan CR, Coburn KA, Hafner BJ, Ballesteros D, Allyn KJ, Friedly JL, Ciol MA, Carter RV, Mertens JC, Krout AJ, Sanders JE. Short partial doffs of release/relock sockets may effectively stabilize limb fluid volume in prosthesis users with transtibial amputation. Clin Biomech (Bristol, Avon) 2023; 106:105986. [PMID: 37210769 DOI: 10.1016/j.clinbiomech.2023.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/18/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND A challenge often faced by people with lower extremity amputation is management of prosthetic socket fit due to changes in fluid volume within their residual limb. Prior research suggests that intermittently doffing the prosthetic socket may help stabilize daily residual limb fluid volume. METHODS To assess the effects of partial doff duration on residual limb fluid volume retention, participants with transtibial amputation were tested by walking on a treadmill in a controlled, laboratory setting under three conditions. An automated system to release the locking pin and enlarge the socket was used to produce the partial doffing. Percent limb fluid volume changes after partial doffing for 4 min (Short Rest) and for 10 min (Long Rest) were compared with no partial doffing (No Release). Limb fluid volume was monitored using bioimpedance analysis. FINDINGS Mean percent fluid volume changes in the posterior region were -1.2% for No Release, 2.7% for Short Rest, and 1.0% for Long Rest. Short and Long Rests had larger increases than No Release (P = 0.005 and 0.03, respectively); Short and Long Rests were not statistically different (P = 0.10). Eight of the thirteen participants experienced a higher percent fluid volume gain for both release protocols while four experienced a higher percent fluid volume gain for only one release protocol. INTERPRETATION A partial doff duration as short as 4 min may be an effective strategy to stabilize limb fluid volume in prosthesis users with transtibial amputation. Trials in at-home settings should be pursued.
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Affiliation(s)
- Conor R Lanahan
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Kendrick A Coburn
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Brian J Hafner
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Daniel Ballesteros
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Katheryn J Allyn
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Janna L Friedly
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Marcia A Ciol
- University of Washington, Department of Rehabilitation Medicine, Seattle, WA, USA
| | - Ryan V Carter
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Joseph C Mertens
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Adam J Krout
- University of Washington, Department of Bioengineering, Seattle, WA, USA
| | - Joan E Sanders
- University of Washington, Department of Bioengineering, Seattle, WA, USA.
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Coburn KA, DeGrasse NS, Allyn KJ, Larsen BG, Garbini JL, Sanders JE. Using magnetic panels to enlarge a transtibial prosthetic socket. Med Eng Phys 2022; 110:103924. [PMID: 36564131 DOI: 10.1016/j.medengphy.2022.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
A novel method is described to connect a prosthetic liner to the panels of an adjustable socket to facilitate limb fluid volume stabilization in prosthesis users. Magnets are placed in the socket panels, and iron powder is embedded in the user's prosthetic liner. When the magnet is in close proximity to the liner, a firm connection is formed. The system's capability to execute panel pull on transtibial prosthesis users was tested. The backs of the panels were supported by a bracket mounted to the external surface of the socket that allowed the radial position of the panels to be adjusted. Bench testing demonstrated an optimized strength-to-weight ratio using 1.27-cm thick annular-shaped magnets supported by 0.32-cm thick backplates. Testing on four people with transtibial amputation showed that the maximum socket increase achieved using magnetic panel pull ranged from 5.3% to 13.8% of the initial (panels flush) socket volume. The results indicate that magnetic panel pull induces a meaningful increase in socket volume during sitting. The clinical relevance is a novel strategy that may help stabilize prosthesis users' limb fluid volume over the day.
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Affiliation(s)
- Kendrick A Coburn
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Nicholas S DeGrasse
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, 98195, United States
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, 98195, United States.
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Scoping review to evaluate existing measurement parameters and clinical outcomes of transtibial prosthetic alignment and socket fit. Prosthet Orthot Int 2022; 46:95-107. [PMID: 35412519 DOI: 10.1097/pxr.0000000000000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Fit and alignment are observable objectives of the prosthesis rendering process for individuals with lower limb amputation. Nevertheless, there is a dearth of validated measures to directly assess the quality of this clinical procedure. OBJECTIVES The objectives of this scoping review are to evaluate existing measurement parameters and clinical outcomes used in investigations of transtibial socket fit or prosthetic alignment and to identify gaps in the literature regarding tools for evaluation of prosthetic fitting. STUDY DESIGN Scoping literature review. METHODS A comprehensive search was conducted in the following databases: MEDLINE (through PubMed), Embase (through Elsevier), Scopus (through Elsevier), and Engineering Village (through Elsevier), resulting in 6107 studies to be screened. RESULTS Sixty-three studies were included in the review. When measuring fit, studies most frequently reported on patient-reported comfort (n = 22) and socket size compared with the residual limb volume (n = 9). Alignment was most frequently measured by the prosthetists' judgment and/or use of an alignment jig (n = 34). The measurement parameters used to determine alignment or fit varied greatly among the included studies. CONCLUSION This review demonstrated that most measures of socket fit rely on a patient's self-report and may vary with biopsychosocial factors unrelated to the socket fitting process. Meanwhile, alignment is determined mostly by the prosthetist's judgment, paired with objective measurements, such as alignment jigs and gait analysis. Efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.
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Weathersby EJ, Vamos AC, Larsen BG, McLean JB, Carter RV, Allyn KJ, Ballesteros D, Wang H, deGrasse NS, Friedly JL, Hafner BJ, Garbini JL, Ciol MA, Sanders JE. Performance of an auto-adjusting prosthetic socket during walking with intermittent socket release. J Rehabil Assist Technol Eng 2022; 9:20556683221093271. [PMID: 35558157 PMCID: PMC9087223 DOI: 10.1177/20556683221093271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction A challenge in the engineering of auto-adjusting prosthetic sockets is to
maintain stable operation of the control system while users change their
bodily position and activity. The purpose of this study was to test the
stability of a socket that automatically adjusted socket size to maintain
fit. Socket release during sitting was conducted between bouts of
walking. Methods Adjustable sockets with sensors that monitored distance between the liner and
socket were fabricated. Motor-driven panels and a microprocessor-based
control system adjusted socket size during walking to maintain a target
sensed distance. Limb fluid volume was recorded continuously. During eight
sit/walk cycles, the socket panels were released upon sitting and then
returned to position for walking, either the size at the end of the prior
bout or a size 1.0% larger in volume. Results In six transtibial prosthesis users, the control system maintained stable
operation and did not saturate (move to and remain at the end of the
actuator’s range) during 98% of the walking bouts. Limb fluid volume changes
generally matched the panel position changes executed by the control
system. Conclusions Stable operation of the control system suggests that the auto-adjusting
socket is ready for testing in users’ at-home settings.
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Affiliation(s)
- Ethan J Weathersby
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Andrew C Vamos
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Brian G Larsen
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Jake B McLean
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Ryan V Carter
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Katheryn J Allyn
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Daniel Ballesteros
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Horace Wang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | | | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joseph L Garbini
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joan E Sanders
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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Gurrey CJ, Garbini JL, Bennett SP, Wang HY, Allyn KJ, Friedly JL, Hafner BJ, McLean JB, Larsen BG, Sanders JE. Socket release/relock: An innovative mechanism to maintain residual limb volume. Med Eng Phys 2021; 90:100-106. [PMID: 33781476 DOI: 10.1016/j.medengphy.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
Management of socket fit is challenging for people using lower-limb prostheses because of residual limb volume fluctuation throughout the day. Releasing socket pressures during sitting (partial doffing) may help users increase their limb volume after they have undergone volume loss earlier in the day. The purpose of this research was to develop and evaluate a system to allow for quick and easy locking pin and socket panel release during sitting and relock upon standing. The system was to allow the partial doff tether length to be custom set for each user, accomplish release and relock in less than 2.0 s each, require only one hand, and require a finger push force comparable to a push button on a phone. A motor-driven release/relock system (<240 g build weight) housed within the socket adjusts locking pin tether length, and an instrumented ratcheting dial adjusts socket panel position. Three participants with a trans-tibial amputation operated the system properly using one hand. For a partial doff, users preferred a tether length between 5 and 6 cm. All users executed release within 1.5 s and relock within 1.5 s.
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Affiliation(s)
- Clement J Gurrey
- Research Engineer/Scientist, Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA, United States
| | - Joseph L Garbini
- Professor, Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Seattle, WA 98195, United States.
| | - Samuel P Bennett
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States
| | - Horace Y Wang
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Katheryn J Allyn
- Research Prosthetist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Janna L Friedly
- Professor, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, 356490, Seattle, WA 98105, United States.
| | - Brian J Hafner
- Professor, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, 356490, Seattle, WA 98105, United States.
| | - Jake B McLean
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States
| | - Brian G Larsen
- Research Engineer/Scientist. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
| | - Joan E Sanders
- Professor. Department of Bioengineering, University of Washington, 355061, 3720 15th Ave NE, Seattle, WA 98195, United States.
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